Rutherford's Section 09: Grafts and Devices скачать в хорошем качестве

Rutherford's Section 09: Grafts and Devices

#VascularSurgery #EndovascularTherapy #Rutherford #GraftsAndDevices #ProstheticGrafts #BiologicGrafts #BioengineeredGrafts #Stents #StentGrafts #AorticRepair This "Deep Dive" summarizes Section 9 (Chapters 65-70) of Rutherford’s Vascular Surgery and Endovascular Therapy, 10th Edition. It covers essential grafts and devices used by vascular surgeons. Prosthetic grafts, developed since the 1950s, are crucial when patient veins aren't suitable. Key materials include Dacron (knitted or woven, used for larger vessels) and ePTFE (compliant, no pre-clotting, common for dialysis access). Challenges include thrombosis and neointimal hyperplasia. Strategies to improve outcomes include vein patches/cuffs, heparin bonding, and regular surveillance via duplex ultrasound. Complications include thrombosis and infection. Biologic grafts are non-autogenous alternatives. Cryopreserved allografts (human) and xenografts (animal) exist but have limitations like immunogenicity, variable patency, and risk of aneurysm. Their use is often for limb salvage when no vein is available or for replacing infected prosthetics. Bioengineered grafts aim for the "holy grail" of an ideal, off-the-shelf conduit. Approaches include processed vessels, biohybrids (synthetic with biological lining), and tissue-engineered grafts built on scaffolds. Humacyte's HAV, an acellular engineered graft, shows promise in trials for dialysis access and peripheral use. Challenges include durability, immune response, and manufacturing. Endovascular devices like stents and stent grafts are ubiquitous. Stents provide mechanical support after angioplasty, addressing recoil and dissection but causing injury and flow changes that contribute to restenosis (neointimal hyperplasia). Types include balloon-expandable (BE) for precision and self-expanding (SE) for flexibility. Drug-eluting stents (DES) reduce hyperplasia but had mortality concerns (Paclitaxel). Stents are used extensively from aortoiliac to below-knee arteries and venous outflow. Aortic endovascular repair (EVAR/TEVAR) is now standard for many aneurysms and dissections. Devices for the thoracic aorta, including standard grafts and newer branched systems for the arch, are evolving. Complex thoracoabdominal aneurysms are increasingly treated with fenestrated or branched grafts (e.g., Cook Z-FEN, T-Branch, Gore T-MVE) to preserve branch vessels. Infrarenal EVAR devices continue to advance, and iliac branch devices like the Gore IBE preserve internal iliac flow. The field changes rapidly, demanding continuous learning.